Which erectile dysfunction drug is best?

All the facts you need to know about different erectile dysfunction pills


What are my options for erectile dysfunction drugs?

Some 50 percent of men aged 40 and older experience some degree of erectile difficulties, with 10 percent reporting complete erection failure. Erectile difficulties become progressively more severe with age, so that some 70 percent of men in their 70s suffer from it. Cardiovascular issues, low testosterone, and other physical health problems are to blame and the condition usually is not reversible. 

There’s no drug that can fix physical health induced erectile difficulties for good, especially if they are in an advanced stage. At that point, not even a healthier life style can reverse it, although it can reduce the risk of further deterioration.

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However, several medications can help you get an erection firm enough to enjoy sexual intercourse. These so-called “impotence agents” are taken on an as-needed-basis and deliver successful results for up to about 80 percent of users. Viagra (sildenafil) and Cialis (tadalafil) perhaps are the most well-known names in the U.S. market, but there are also two other options: avanafil (Stendra) and vardenafil (Levitra, Staxyn). All of them are available for sale in generic versions and taken orally.


All four drugs operate in the same manner, i.e., by increasing the blood volume supplied to the penis, which can give you a firm erection provided that you are sexually aroused. The drugs on their own don’t boost your sexual appetite; that instead has come from sexual stimuli such as an extensive foreplay. 


There still are minor variations in chemical makeup, which means the four drugs work differently from man to man in terms of effectiveness and duration. Therefore, doctors often led their patients try several of them before settling on one for good. Often, costs and insurance coverage limits are determining factors as well.   


How do erectile dysfunction pills work?

All four drugs can be taken shortly before you plan on having sex. Sildenafil and vardenafil take 30-60 minutes to kick in and are best taken on an empty stomach. Food tends to neutralize their effectiveness. In contrast, tadalafil requires 30-45 minutes to set in and for avanafil it’s 15-30 minutes. Both can be taken with food and thus are the obvious choice for after-dinner sex. 


If you are in a real hurry — the kind of sex you can’t plan for — vardenafil is available as a fast-dissolving tablet (Staxyn) that’s placed under your tongue and works its “on-demand” magic in a few minutes. If you don’t want to plan your sex life or hate waiting, you can also take tadalafil as a daily medication and then always be combat ready.  


The effective duration of each drug also varies, but all of them last for at least 4 hours. Plenty of time, given that the average duration of intercourse in the U.S. population is 5 ½ minutes. One dose of tadalafil even lasts for 24-36 hours, which is why tadalafil is ideal for regular use.  


Factors to consider when choosing erectile dysfunction treatments

Initially, it will take some trialing to figure out which drug works best for you. You’ll need to work closely with your doctor on this, since all four options are prescription drugs in the U.S. market, i.e., they can’t be bought over the counter.  


Getting a prescription is easy, though, and licensed online pharmacies often issue them free-of-charge. Beware of internet offerings that sell erectile dysfunction drugs without prescription. Often these are fake and/or impure products that can harm your health. 


Another point to consider are side effects and contraindications with other medications. Common side effects of impotence agents are headaches, irritated stomachs and diarrhea, urinary tract infection, dizziness, and skin rashes. There’s also a risk of getting hour-long erections, which requires immediate medical attention. 


Erectile dysfunction drugs shouldn’t be taken in combination with nitrate cardiac drugs (like dilatrate-SR or isonate) as that can send your blood pressure to dangerously low levels. There have been cases where sildenafil was mixed into sex supplements without stating so on the label, which led to fatal interactions with nitrate drugs.  


Also, don’t take impotence agents at the same time as alpha blockers; leave at least a 4 hour gap between the two. 


Talk to your doctor to get a more detailed understanding of what the potential side effects and contraindications of these impotence drugs are and how they differ from each other.  



  1. Prins, J, et al. “Prevalence of Erectile Dysfunction: A Systematic Review of Population-Based Studies.” International Journal of Impotence Research, vol. 14, no. 6, 2002, pp. 422–32,, Accessed 10 Jan. 2020.
  2. McMurray, James G, et al. “Long-Term Safety and Effectiveness of Sildenafil Citrate in Men with Erectile Dysfunction.” Therapeutics and Clinical Risk Management, vol. 3, no. 6, 2007, pp. 975–81, Accessed 10 Jan. 2020.
  3. Zhou, Zhongbao, et al. “Meta-Analysis of the Long-Term Efficacy and Tolerance of Tadalafil Daily Compared With Tadalafil On-Demand in Treating Men With Erectile Dysfunction.” Sexual Medicine, vol. 7, no. 3, Sept. 2019, pp. 282–291,, Accessed 10 Jan. 2020.
  4. Martin-Morales, Antonio. “Vardenafil for the Treatment of Erectile Dysfunction: An Overview of the Clinical Evidence.” Clinical Interventions in Aging, Dec. 2009, p. 463, Accessed 10 Jan. 2020.

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